What is the Hepatitis B (Hep B) vaccine schedule?

From the Guidelines

The Hepatitis B vaccine schedule for adults consists of two or three doses, with the most common schedule being two doses at 0 and 1 month for Heplisav-B, or three doses at 0,1, and 6 months for Engerix-B and Recombivax HB, as recommended by the Advisory Committee on Immunization Practices in 2022 1. The vaccine provides protection against hepatitis B virus infection by stimulating the immune system to produce antibodies.

• For adults who need accelerated protection, an alternative schedule with doses at 0,1, and 4 months or 0,7, and 21 days (with a booster at 12 months) may be used, as seen with the Twinrix vaccine 1.
• Certain high-risk individuals, such as those with compromised immune systems or on dialysis, may require a higher dosage or additional doses to achieve adequate immunity, with Engerix-B recommended as a series of 4 doses for adults on hemodialysis 1. Key points to consider when administering the Hepatitis B vaccine include:
• The vaccine is highly effective, with more than 90% of healthy adults developing protective antibodies after completing the series 1.
• Side effects are generally mild and may include soreness at the injection site, low-grade fever, or fatigue.
• The protection from the complete series is long-lasting, and routine booster doses are not recommended for immunocompetent individuals 1. It is essential to follow the recommended schedule and dosage to ensure optimal protection against hepatitis B virus infection, as outlined in the 2022 recommendations from the Advisory Committee on Immunization Practices 1.

From the FDA Drug Label

The usual immunization regimen (see Table 1) consists of 3 doses of vaccine given according to the following schedule: first dose: at elected date; second dose: 1 month later; third dose: 6 months after first dose. Table 1. Recommended Dosage and Administration Schedules Group Dose Schedules Infants born of: HBsAg-negative mothers 10 mcg/0. 5 mL 0,1,6 months HBsAg-positive mothers 10 mcg/0.5 mL 0,1,6 months Children: Birth through 10 years of age 10 mcg/0.5 mL 0,1,6 months Adolescents: 11 through 19 years of age 10 mcg/0.5 mL 0,1,6 months Adults (>19 years) 20 mcg/1.0 mL 0,1,6 months

The Hepatitis B vaccine schedule is as follows:

• Infants: 0,1, and 6 months
• Children (birth through 10 years): 0,1, and 6 months
• Adolescents (11 through 19 years): 0,1, and 6 months
• Adults: 0,1, and 6 months 2

From the Research

Hepatitis B Vaccine Schedule

• The hepatitis B vaccine is a highly effective tool in preventing hepatitis B infection and its related morbidity and mortality 3.
• According to a study published in 2022, three safe and effective vaccines are available in the United States and other countries for HBV prevention, and the benefits of vaccination in preventing infection and its sequelae have been substantiated 4.
• A new Food and Drug Administration-approved vaccine is available that offers a high degree of immunogenicity after 2, rather than 3, injections 4.
• The efficacy and safety of hepatitis B vaccine strategies have been explored in a 2024 umbrella review of meta-analyses, which found highly suggestive evidence supporting HepB booster and HepB with 1018 adjuvant for improved seroprotection 5.
• Targeted vaccination could effectively reduce HBV infection, and adjuvant and booster vaccinations enhance seroprotection without significant reaction 5.

Vaccine Administration

• The hepatitis B vaccine is typically administered in a series of 3 doses, with the first dose given at birth, the second dose given at 1-2 months of age, and the third dose given at 6-18 months of age.
• Booster doses may be recommended for certain individuals, such as those with compromised immune systems or those who are at high risk of exposure to the virus 5.
• The vaccine can be administered to individuals of all ages, from infants to adults, and is recommended for all individuals who are at risk of exposure to the virus 4.

Special Considerations

• Certain individuals, such as those with obesity or genetic polymorphisms, may have a reduced response to the hepatitis B vaccine 5, 6.
• The emergence of vaccine escape mutants has been a concern, but the overall impact of these mutants seems to be low and they do not pose a public health threat or a need to modify the established hepatitis B vaccination programs 6.